Procalcitonin & Antibiotic Decisions

The advent of antibiotic therapy has led to dramatic reductions in mortality and morbidity due to bacterial infections and sepsis. The overuse of antibiotics to treat infections, however, may expose patients to adverse events resulting from use of these agents and by increasing the risk of developing bacterial resistance. To fight the emergence of bacterial resistance to antimicrobial agents, more effective efforts are needed to reduce the inappropriate or unnecessarily prolonged use of antibiotics. A novel approach for determining the need and optimal duration of antibiotic therapy is to use biomarkers of bacterial infections (see also, Procalcitonin: A Biomarker for Early Sepsis Intervention). One such biomarker is procalcitonin (PCT), which has been shown to become up-regulated during bacterial infections. It also appears to mirror the extent and severity of infections. Measuring PCT levels may help physicians more rationally decide on prescriptions and duration of antibiotic therapy in patients with infections. Previous studies have suggested that using clinical algorithms based on PCT levels results in less antibiotic use without negatively affecting clinical outcomes. However, various trials using such algorithms have been conducted largely in European healthcare settings. New Data from Procalcitonin Algorithms In the August 8, 2011 Archives of Internal Medicine, my colleagues and I performed a systematic review of 14 randomized controlled trials that investigated PCT algorithms for antibiotic treatment decisions in adults with respiratory tract infections and sepsis from primary care, ED, and ICU settings. The aim was to summarize the evidence for using PCT measurements and to propose clinical algorithms for use in future trials in the United States. Our analysis revealed no significant differences in mortality...